Treatments for Multiple Sclerosis

Medications used to control MS have been shown to slow the progression of the disease and prevent and bring relapses under control. Unfortunately, medications currently available to treat MS have to be administered by injection and they have a number of side effects. Sometimes people who are in remission, symptom free, or who cannot see improvements question the effectiveness of their medications and are tempted to stop using them. However, plaques continue to form whether symptoms are present or not and a number of medications have been shown to slow this process. These improvements, though valuable, are not visible. It is important for people to stay on their medications unless their health care provider advises them to stop using it.

Immunomodulating drugs

Immunomodulating drugs are used to bring the immune system to a desired level. Those approved for the treatment of MS include:

• Avonex interferon beta-1a
• Betaseron interferon beta-1b
• Rebif interferon beta-1a
• Copaxone glatiramer acetate
• Tysabri natalizumab

Avonex, Betaseron, and Rebif are beta interferons used to treat relapsing remitting MS. These medications are often self injected, since they are given as subcutaneous injections. They have been shown to reduce the number of relapses and when relapses do occur they tend to be shorter and less severe.

Side effects of interferon beta

Medications that modify the body?s immune system can potentially alter the body?s ability to fight infections. Patients commonly experience flu-like symptoms when interferon beta injections are started. These symptoms tend to decrease in frequency and severity with ongoing use. Do not stop or alter treatment unless your health care provider recommends that you do so.

Tell your doctor if any of the following side effects become severe or do not go away:

• tight muscles
• dizziness
• numbness, burning, tingling, or pain in hands or feet
• joint pain
• stomach pain
• eye problems
• runny nose
• toothache
• hair loss
• bruising, pain, redness, swelling, bleeding, or irritation at the injection spot

The following symptoms are uncommon, but may indicate serious problems. Contact your health care provider immediately if you experience any of the following side effects:

• depression, thoughts of harming yourself or suicide, very emotional
• hallucinations (seeing things or hearing voices that do not exist)
• seizures
• unexplained weight gain or loss
• feeling cold or hot all the time
• trouble breathing when lying flat in bed
• painful or difficult urination or increased need to urinate during the night
• decreased ability to exercise
• chest pain or tightness, fast or irregular heartbeat
• pale skin
• excessive tiredness
• loss of appetite
• unusual bleeding or bruising
• pain or swelling in the upper right part of the stomach
• yellow skin or eyes, dark brown urine, light-colored bowel movements
• sore throat, cough, or other signs of infection
• hives, rash, itching
• swelling of the face, throat, tongue, lips, eyes, hands, arms, feet, ankles, or lower legs
• difficulty breathing or swallowing
• hoarseness
• flushing

>Glatiramer acetate (Copaxone), once called copolymer I, is a synthetic form of myelin basic protein. It is a subcutaneous injection given daily, often by self-injection, to treat relapsing-remitting MS. In studies it has been shown to reduce the relapse rate by almost one third.

Side effects of Glatiramer

Tell your doctor if any of the following symptoms become severe or do not go away.

• pain, redness, swelling, itching, or lump in the place where you injected glatiramer
• weakness, flushing
• depression, abnormal dreams
• severe headache, pain in the back, neck, or any other part of the body
• loss of appetite, diarrhea, upset stomach, vomiting
• weight gain
• swelling of the hands, feet, ankles, or lower legs
• purple patches on skin
• joint pain
• confusion, nervousness, crossed eyes, difficulty speaking
• shaking hands that you cannot control
• sweating
• ear pain
• painful or changed menstrual periods, vaginal itching and discharge
• urgent need to urinate or defecate
• tightness in muscles
• white patches in the mouth

The following symptoms are uncommon, but may indicate a serious problem. If you experience any of the following symptoms contact your health care provider immediately.

• Dizziness
• excessive sweating
• chest pain
• sore throat, fever, chills, and other signs of infection
• runny nose, coughing
• fast heartbeat, fainting
• skin rash, hives, itching, difficulty breathing or swallowing
• very severe pain at the injection site

Natalizumab (Tysabri) is a monoclonal antibody which has been shown in clinical trials to significantly reduce the frequency of attacks in people with relapsing forms of MS. Because of the risk of Progressive Multifocal Leukoencephalopathy (PML)(a rare infection of the brain that cannot be treated, prevented, or cured and that usually causes death or severe disability), natalizumab is usually used by people who have failed to respond to other medications for MS or who are unable to take other MS medications. To minimize the risk of PML a program called TOUCH has been set up to monitor and manage patients receiving natalizumab. In the US only those patients, physicians and infusion centers registered with the TOUCH program are allowed to receive, prescribe or administer natalizumab. Estimated risk for PML associated with natalizumab appears to be approximately 1 in 1000. Initially PML had been seen in patients who had received natlaizumab in combination with other MS treatments. Unfortunately, recently two cases of PML have been seen in patients who received natalizumab alone. Signs of PML may include new or worsening neurological symptoms such as changes in thinking, eyesight, balance, strength or other symptoms. Any new or worsening symptoms should be reported immediately to your physician.

Natalizumab is administered by infusion into the vein generally over a one hour period and on a monthly basis. Patients should be observed during the infusion period for signs of an allergic reaction.

Side effects of Natalizumab

Tell your doctor if any of these symptoms are severe or do not go away:

• headache
• extreme tiredness
• joint pain or swelling, pain in arms or legs, swelling of the arms, hands, feet, ankles, or lower legs, muscle cramps
• stomach pain, heartburn, diarrhea, constipation, gas
• weight gain or loss
• depression
• night sweats
• painful, irregular, or missed menstruation (period)
• swelling, redness, burning, or itching of the vagina, white vaginal discharge
• frequent or painful urination, urgent need to urinate, difficulty controlling urination
• tooth pain
• cold sores

If you experience any of the following symptoms notify your health care provider immediately as they may be a sign of a serious problem.

• sore throat, fever, cough or other signs of infection
• rash, hives, itching, difficulty breathing
• chest pain
• dizziness, chills, flushing
• yellowing of the skin or eyes
• nausea, vomiting
• unusual darkening of the urine

Immunosuppressant

Mitoxantrone(Novantrone) is an immunosuppressant used to treat advanced or chronic MS. It should be administered by slow intravenous infusion under the supervision of a physician experienced in the use of cytotoxic chemotherapy agents.

There is an increased risk of acute myelogenous leukemia and cardiac toxicity with the use of mitoxantrone. Because risks associated with the use of the medication increase with the use of the drug over time, patients with multiple sclerosis should not receive a cumulative dose greater than 140 mg/m2.2

Patients should read and discuss the U.S. FDA Black Box Warning for mitoxantrone with their health care provider before beginning treatment.

Side effects of Mitoxantrone

Tell your doctor if any of these symptoms are severe or do not go away:

• nausea, vomiting, heartburn, loss of appetite
• diarrhea, constipation
• sores on the mouth and tongue
• runny or stuffed nose
• thinning or loss of hair
• changes in the area around or under fingernails and toenails
• missed or irregular menstrual periods
• extreme tiredness, weakness
• headache, back pain

If you experience any of the following symptoms call your doctor immediately:

• unusual bleeding, bruising, small red or purple dots on the skin
• hives, itching, rash
• difficulty swallowing, shortness of breath
• fainting, dizziness
• pale skin
• yellowing of the skin or eyes
• seizures
• redness, pain, swelling, burning, or blue discoloration at the site where the injection was given

Corticosteroids

Corticosteroids are used to reduce the duration and severity of relapses in some patients with MS; however, they do not appear to alter the course of the disease.

A short course of treatment with intravenous methylprednisolone (Solu-Medrol) followed by oral steroids is sometimes used to bring optic (eye) symptoms under control during a relapse.